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To the casual listener, President Barack Obama’s promises on health care Tuesday may have sounded like an unequivocal vow to get all Americans health insurance coverage by the end of 2009.

But in reality, that’s not exactly what he pledged Tuesday night.

Obama stressed the importance of “quality, affordable health care for every American” and struck an urgent tone. “Let there be no doubt: health care reform cannot wait, it must not wait and it will not wait another year,” Obama said.

But in truth, Obama’s speech contained several caveats and deliberately avoided language that could box in Obama as he turns swiftly toward health reform in coming weeks.

For one thing, Obama spoke of making a “down payment on the principle” of getting affordable health care for every American. It’s a phrase that shows Obama believes that it could take some time to get everyone on board, and that helping everyone is a goal rather than a reality that will be achieved in the near future.

Parsing his statements even more closely, Obama never actually said he would get insurance coverage for all, just “quality, affordable health care.”

And he stopped well short of setting any final timetable on broad-based healthcare – and also avoided the sweeping notion of providing “universal health care” to Americans, a phrase Obama himself largely avoids.

During his campaign, he was more specific than he was last night. ''We can have universal health care by the end of the next president's first term, by the end of my first term,'' Obama told a union convention in March 2007.

But if Obama left himself some wiggle room on the timing and particulars of a plan, he made clear he’ll tackle it soon – even amidst the economic meltdown.

In fact, Obama said he believes solving the health-care crunch is an integral part to solving the recession – that he must do one to accomplish the other. In fact, Obama’s talk on health-care often seems to spring more from the brain of an economist than the heart of a caregiver, as he often paints the solution in budgetary terms rather than in humanitarian ones.

“It’s a step we must take if we hope to bring down our deficit in the years to come,” Obama said.

Obama pledged to convene a health-summit next week that will bring together “businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue.”

And advocates on both sides at the issue will get a clearer picture of what Obama has in mind when he releases his first budget Thursday.

Already some who favor universal coverage are watching Obama’s words – and actions – very closely.

Ron Pollack of Families USA said he would accept a bill that phased in universal coverage. But he said before Obama’s address that “piecemeal” legislation that covered some people now and left others to be dealt with later would be “truly troublesome.”

Obama’s delicate dance on health care reform is made more difficult by the fight he had with Hillary Clinton over the issue during the Democratic primary contest last year. Clinton favored requiring all Americans to get insurance—in policy parlance, a mandate.

Obama rejected that approach, saying he expected that most uninsured people would buy coverage if it was cheap enough. Obama isn’t expected to endorse the mandate many experts say is essential to achieve “universal” coverage — but he’s also expected to go along in the likely event that Congress includes one in health reform legislation.

A blogger with the American Prospect, Ezra Klein, reported Tuesday that Obama’s new budget will strike an aspirational tone, by urging Congress to “aim for universality.” White House spokesmen declined to confirm that language, though one top budget official did take issue with a portion of the Prospect report that said the budget’s wording on health care “is changing hourly.”

“The budget overview has been at the printer since Friday,” said the official, who asked not to be named.

Readers' Comments (16)

So in a laundry list of sometimes opposing wants, that far surpassed the perceived revenue of any tax increase he has promised, when he said he'd have to give up something too, what was he talking about? The words come out of his mouth so fluidly, it's almost like he's saying something.

Like in every other civilized country, it'll be taken out of your paycheck, just like private insurance. The difference will be the price, particularly if everybody signs up. By the way, what do you mean with 'not substituting employer-subsidized medical coverage'? What if your employer doesn't provide that, or provides insurance that sucks, or decides to cut back and you can no longer afford it?

It doesn't matter what you call it, because something simply has to be done with runaway health care costs. When Health Insurance Companies profits grew faster than Fortune 500 companies over the last 5 years and the average health care cost for the average American family exceeds $8,500 per year, it's clear the system is gorged with corruption and profiteering which is being passed to the American families. It's a disgrace in this country when families lose their homes every day just because of medical costs while people in Canada and the UK receive medical care for NO COST. Moreover, it's quality service as any resident of either the UK or Canada will attest. The pharmesuitcal companies and the health insurance carriers and their stockholders are getting filthy rich while Americans suffer and it keeps getting worse. It's no different than Wall Street and the Auto Manufacturers in terms of corruption and mismanagement and ill gotten profits. Of course, those lawmakers who are being paid large sums of money by the drug companies and the Health Insurance Scammers will try again to kill the effort because it would end their dipping into the pockets of American citizens. (check the records and see who received what and how much from these entities in the past to keep health care off the agenda) Of course, as could be expected, the Republians will start their annual rherotic accusing the President of being a socialist and anything else they can think of to keep the status quo. Why? They're making too much money off the present system. They don't care about main street.....they're a party of the Corporations and the AMA. Good luck Obama!

when he said he'd have to give up something too, what was he talking about?

This phony jerk knows not nor will he, about giving anything up. This ol' boys a taker with a slick way of talking and a trained expert at taking a seed of truth and layering with fancy double talk filled with half-truths and down right lies which any good socialist or commie is taught to master from a very young age. He is a chosen, educated and faux AFRICAN AMERICAN...that has no clue about the REAL African American culture nor does he really care about them other than what price it will take for him to buy them body and soul, anymore than he cares about any of us that are not or will not buy into his socialist agenda for this country. Yes, he's a taker and by this 200 billion extra tax payers money he plans to guarantee mortgage financing for more than 80 percent of the home value...he may very well take away the American dream of being a home owner for our children and grand children

You can't pay for these things. Stating he would do away with programs that don't work? He can't, that has to be Congress. And Congress has these programs because they wanted them for their voters. They won't do away with them. Stupid.

Think a minute for the cost of all these programs he promises. He can't afford them. We can't afford them.

It was idiotic when the whole crowd stood up when he mentioned that surplus will stop going to the wealthy. Almost everyone in Congress is a Millionare to begin with. Know when you think they only get paid 200K a year, how the hell do most have more money when they leave Congress.

One way we will pay for all this is by reducing health care costs. If you were lucky enough to have been tuned into C-Span at the right moment, you would have heard that (1) the highest Medicare costs come within hours, days, and weeks of death and (2) it would behoove all Medicare recipents to have a living will. [My paraphrase.] I can't think of a clearer warning that health care rationing is coming.

Recommended reading: Tom Daschle's book, Critical: What We Can Do About the Health-Care Crisis. It's all laid out for you.

Don't think America gets Obama yet. Americans you just do not get it. Some of us do and have been speaking out.The point is,,, Obama HAS THE VISION, BUT YOU PAY FOR IT. He simply channels what you want in your mind of utopian America, and he packages it with inspirational,, hope filled speeches,,, with no details on cost or, how much you pay. It is working Americans, who pay for all, and 20-40% on your wallets. Ever been to a charity fundraiser that is for a questionable cause or unrealistic goal and ended up handing a 1000$ check over? You got inspired. Or going to Vegas and getting wrapped up in the BlackJack table because one person won 1500$ and you want it too?.................................................................. Inspired. That's POTUS Obama. Until America wakes up, with the cost of doing business, the press is all for him, and after his speeches his approval rating goes higher. Americans do not want reality, they do not care how much debt they or America will be in, or what kind of problems come with too much spending. Americans have lived off of credit for years, want a fix of spending to get out of it, and Obama is just cranking up that spending to get you all ready for the big charity event. However, one problem is big business isn't with him and they create jobs. That's Obama's problem in this, no jobs means no pay out from Americans. Big business, including Walmart will make it's money overseas. Jobs will go away and charity will be on the wallets of every American.

Deal with health care or it will swamp the whole economy, small businesses, large corporations, and Medicare will take down the government. I admire Barack Obama for telling us the game is up. We can no longer just avoid these big elephants in the closet. We have to deal with them. I wish Obama the best.

So many people have so many opinions of an industry they know nothing about....

1. It is true that you will accrue 90% of your Medicare expenditures within 2 weeks of your death. That is not a Medicare issue-it is an issue of defensive medicine and Americans love of catastrophic medicine-you know, emergency heart surgery, dialysis, feeding tubes, etc. The truth is, life is a fatal condition and we all will die. The question is 1. would you rather die in an ICU on life support or at your home with hospice care?

2. Providing health insurance to everyone in the country will just feed the beast of the health insurance industry. Our per capita health care costs are twice that of every other industrialized country in the world and we have the lowest life expectancy and highest infant mortality. Your health care premium has 30% devoted to adminstrative costs and 20% going to physician services. The cheapest alternative is single payer government sponsored health care-it's ironic that John McCain didn't advocate it considering he's been in governmental sponsored programs his whole life-from a DoD dependent to active duty to military retired to governmental service. He instead wanted to count your employer sponsored health insurance as income and tax it accordingly. And, do not think employer sponsored health insurance is another employment tax-it is.

Sure, McCain may not have raised your taxes-he would have just raised your taxable income

The truth is...the system is collapsing. We will have a system eventually that doesn't consume 13% of the GDP(a nonsustainable figure). The real question is, do we rationally devise a plan or do we throw something together in a panic?

for your perusual, figures from the American College of Physician (note that Germany, a country with socialized medicine, had the best access to health care professionals)

health care cost for the average American family exceeds $8,500 per year, it's clear the system is gorged with corruption and profiteering which is being passed to the American families. It's a disgrace in this country when families lose their homes every day just because of medical costs while people in Canada and the UK receive medical care for NO COST. Moreover, it's quality service as any resident of either the UK or Canada will attest.

I agree that prices are too high for health insurance, but part of that blame lies w/ all the frivolous lawsuits that have happened over the last 3 decades that have driven the cost of malpractice insurance for the doctors and hospitals that they have to carry... just like businesses that "don't pay any taxes"... the cost is passed down to the consumer or patient, in this case. As for those other countries... answer me this one question... why is it that all the leaders/wealthy from other countries around the world come to the USA for any medical issues they have that they can't get back home? There's something broken in our system, but looking at how "universal health care" is run in other countries (GB, Italy, Germany, France, etc...), I don't think it's the solution for our country.

Don't think America gets Obama yet. Americans you just do not get it. Some of us do and have been speaking out.The point is,,, Obama HAS THE VISION, BUT YOU PAY FOR IT. He simply channels what you want in your mind of utopian America, and he packages it with inspirational,, hope filled speeches,,, with no details on cost or, how much you pay. It is working Americans, who pay for all, and 20-40% on your wallets. Ever been to a charity fundraiser that is for a questionable cause or unrealistic goal and ended up handing a 1000$ check over? You got inspired. Or going to Vegas and getting wrapped up in the BlackJack table because one person won 1500$ and you want it too?.................................................................. Inspired. That's POTUS Obama. Until America wakes up, with the cost of doing business, the press is all for him, and after his speeches his approval rating goes higher. Americans do not want reality, they do not care how much debt they or America will be in, or what kind of problems come with too much spending. Americans have lived off of credit for years, want a fix of spending to get out of it, and Obama is just cranking up that spending to get you all ready for the big charity event. However, one problem is big business isn't with him and they create jobs. That's Obama's problem in this, no jobs means no pay out from Americans. Big business, including Walmart will make it's money overseas. Jobs will go away and charity will be on the wallets of every American.

It is said by Pres. Obama in his campaign speech that he will be very more concern in his people sakes. Health issues are one of Pres. Obama's agenda just like the economic recession as well as poverty, unemployment and environment issues that we are facing up. But did you hear the issue about ACORN? Well, ACORN fell far from their liability tree, and they losing fast in their credibility and winding up as being portrayed as nuts. The Congressional representatives were progressively more resistant on listening to the group, after allegations (even some convictions) of voter fraud, and other abnormalities for a social altruism group. President Obama and his ties to this band of malcontents are coming under more scrutiny, especially after the introduction of HR 1388, a bill that would virtually mandate volunteer activities – indistinguishable to a violation of the Constitution. I think they may all need payday loans, because if they keep up their tomfoolery, everyone on the board of ACORN may have to get new job. Well president, I do think you should act faster before you realize you have nothing but miseries of your people. Well for me, health, economy and poverty must be always in president agenda!all

When I was young, America was the richest nation on the face of the planet. In my lifetime, bad choices by our leaders have left America the world's biggest debtor nation. Would you hire someone with that resume to fix the healthcare problem?

Providing universal health care is not one of the enumerated powers of the Federal Government. So, why isn't Obama following the constitutionally proscribed amendment process?

If Bill and Hillary had initiated their bid for universal health care as an amendment to the constitution, the debate might be coming to a close now. And if enormous, costly, new responsibilities are to be given the federal government, shouldn't the debate be long, deliberate and involve the States and the people?

If government requires all Americans to buy health care, doesn't it have to be accomplished via a huge new tax? Can we the people permit government to tell us how to spend after tax dollars? What would define disposable income?

Obama uses the analogy if you want to drive you must buy auto insurance. However, driving is a privilege and a choice. Individual existence is a choice made by our parents and suicide is both a sin and a crime.

I wish all Americans life, liberty and the pursuit of happiness within the constraints of our republic's constitution.

Bring John Shadegg's Enumerated Powers Act to a Vote It's time for Congress to, "Cite it, chapter and verse." Where do they derive their authority? When they pass new laws or spend taxpayer money, they should be required to point to specific language in the Constitution. The Enumerated Powers Act would require them to do precisely that. Help us bring this bill to a vote.